Diagnostic test accuracy of screening tools for the detection of neurocognitive disorders in older adults post-trauma in acute care settings: a systematic review

Niamh A Merriman¹, Mary E Walsh^{2

3}, Helena Ferris⁴, Eithne Sexton⁵, Niamh O'Regan⁶, Rose S Penfold⁷, Marie Carrigan⁸, Tara Coughlan^{9

10}, Lorna Gurren¹¹, Jodie Adams^{12

13}, Chris Reidy⁶, Arveen Jeyaseelan⁶, Patrick Doyle⁶, Mubashra Ashraf⁶, Tomás Ó Flatharta⁶, Siofra Hearne⁶, Jane Gaffey¹¹, Louise Brent^{5

14}, Pamela Hickey¹⁴, Catherine Blake²

Affiliations

¹ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. niamh.merriman1@ucd.ie.
² School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
³ School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland.
⁴ Department of Public Health, Health Service Executive - South West, St. Finbarr's Hospital, Cork, Ireland.
⁵ School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland.
⁶ Waterford Integrated Care for Older People, Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland.
⁷ Ageing and Health, Usher Institute, University of Edinburgh and Advanced Care Research Centre, Edinburgh, Scotland, UK.
⁸ Health Information and Quality Authority, Dublin, Ireland.
⁹ Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
¹⁰ Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland.
¹¹ School of Psychology, Dublin City University, Dublin, Ireland.
¹² Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK.
¹³ Department of Physiotherapy, Guys and St. Thomas's NHS Foundation Trust, London, UK.
¹⁴ National Office of Clinical Audit, Dublin, Ireland.

PMID: 40824357
DOI: 10.1007/s41999-025-01287-9

Review

Diagnostic test accuracy of screening tools for the detection of neurocognitive disorders in older adults post-trauma in acute care settings: a systematic review

Niamh A Merriman et al. Eur Geriatr Med. 2025.

. 2025 Aug 18.

doi: 10.1007/s41999-025-01287-9. Online ahead of print.

Authors

Affiliations

¹ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. niamh.merriman1@ucd.ie.
² School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
³ School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland.
⁴ Department of Public Health, Health Service Executive - South West, St. Finbarr's Hospital, Cork, Ireland.
⁵ School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland.
⁶ Waterford Integrated Care for Older People, Department of Geriatric Medicine, University Hospital Waterford, Waterford, Ireland.
⁷ Ageing and Health, Usher Institute, University of Edinburgh and Advanced Care Research Centre, Edinburgh, Scotland, UK.
⁸ Health Information and Quality Authority, Dublin, Ireland.
⁹ Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
¹⁰ Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland.
¹¹ School of Psychology, Dublin City University, Dublin, Ireland.
¹² Department of Population Health Sciences, School of Life Course and Population Sciences, Kings College London, London, UK.
¹³ Department of Physiotherapy, Guys and St. Thomas's NHS Foundation Trust, London, UK.
¹⁴ National Office of Clinical Audit, Dublin, Ireland.

PMID: 40824357
DOI: 10.1007/s41999-025-01287-9

Abstract

Purpose: Neurocognitive disorders (NCDs), including delirium, cognitive impairment, or dementia, are prevalent in older patients with physical trauma in acute care settings. Identifying NCDs in these patients can enhance care decisions to improve outcomes. This study aimed to identify the diagnostic accuracy of screening tools for NCDs in older patients with trauma in acute care settings.

Methods: Electronic databases (MEDLINE, Embase, CINAHL, PsycInfo, Cochrane Library) were searched from inception to 01 March 2024. Inclusion criteria were: older adults (≥ 60 years); admitted to acute care setting following physical trauma; diagnostic accuracy study of a screening tool for (1) delirium and/or (2) cognitive impairment or dementia against a reference standard of a clinical diagnosis (standard diagnostic criteria or validated tool). Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A narrative synthesis was conducted. Methodological heterogeneity between the studies precluded meta-analysis.

Results: Five studies examining five different screening tools for delirium in older adults, all with hip fracture, were included. Studies reported wide variance in sensitivity (76.9-91.8) and specificity (54.5-99). Prevalence of detected delirium varied widely across studies (6.7-31.5%). All studies had a high or unclear risk of bias in at least one domain. No studies were found to examine the diagnostic accuracy of screening tools for cognitive impairment in older patients with trauma.

Conclusion: This systematic review highlights the dearth of studies validating screening tools for NCDs in older patients following trauma in acute care settings.

Prospero registration number: CRD42024518730.

Keywords: Cognition; Delirium; Diagnostic accuracy; Hip fracture; Older adults; Systematic review.

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Conflict of interest statement

Declarations. Competing interests: The authors have no competing interests to declare that are relevant to the content of this article. Ethics approval: Ethical approval and written consent were not required.

References

1. Government of Ireland. A Trauma System for Ireland: Report of the Trauma Steering Group. [Internet]. Ireland. 2018. https://www.gov.ie/en/publication/c8640e-a-trauma-system-for-ireland-rep... . Accessed 29 March 2024.
1. National Office of Clinical Audit. Major Trauma Audit National Report 2021 [Internet]. Dublin, Ireland. National Office of Clinical Audit. 2023. https://www.noca.ie/documents/major-trauma-audit-national-report-2021/ . Accessed 2 February 2025.
1. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association, Washington, DC
1. World Health Organization. WHO Dementia Factsheet [Internet]. Geneva. World Health Organization. 2023. https://www.who.int/news-room/fact-sheets/detail/dementia . Accessed 19 February 2025.
1. Fogg C, Griffiths P, Meredith P, Bridges J (2018) Hospital outcomes of older people with cognitive impairment: an integrative review. Int J Geriatr Psychiatry 33(9):1177–1197. https://doi.org/10.1002/gps.4919 - DOI - PubMed - PMC

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Diagnostic test accuracy of screening tools for the detection of neurocognitive disorders in older adults post-trauma in acute care settings: a systematic review

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Diagnostic test accuracy of screening tools for the detection of neurocognitive disorders in older adults post-trauma in acute care settings: a systematic review

Authors

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Abstract

Conflict of interest statement

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